Provider First Line Business Practice Location Address:
939 W MARKET ST
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
LIMA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45805-2738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-228-5434
Provider Business Practice Location Address Fax Number:
419-228-4620
Provider Enumeration Date:
11/08/2005